Measles

A randomized, controlled trial of vitamin A in children with severe
measles.

Hussey GD; Klein M
N Engl J Med 1990 Jul 19;323(3):160-4

BACKGROUND.
Measles kills about 2 million children annually, and there is no specific
therapy for the disease. It has been suggested that vitamin A may be of
benefit in the treatment of measles. METHODS. We conducted
a randomized, double-blind trial involving 189 children who were hospitalized
at a regional center in South Africa because of measles complicated by
pneumonia, diarrhea, or croup. The children (median age, 10 months) were
assigned to receive either vitamin A (total dose, 400,000 IU of retinyl
palmitate, given orally; n = 92) or placebo (n = 97), beginning within
five days of the onset of the rash. At base line, the characteristics
of the two groups were similar. RESULTS. Although clinically
apparent vitamin A deficiency is rare in this population, the children's
serum retinol levels were markedly depressed (mean [+/- SEM], 0.405 +/-
0.021 mumols per liter [11.6 +/- 0.6 micrograms per deciliter]), and 92
percent of them had hyporetinemia (serum retinol level less than 0.7 mumols
per liter [20 micrograms per deciliter]). Serum concentrations of retinol-binding
protein (mean, 30.1 +/- 2.0 mg per liter) and albumin (mean, 33.4 +/-
0.5 g per liter) were also low. As compared with the placebo group, the
children who received vitamin A recovered more rapidly from pneumonia
(mean, 6.3 vs. 12.4 days, respectively; P less than 0.001) and diarrhea
(mean, 5.6 vs. 8.5 days; P less than 0.001), had less croup (13 vs. 27
cases; P = 0.03), and spent fewer days in the hospital (mean, 10.6 vs.
14.8 days; P = 0.01). Of the 12 children who died, 10 were among those
given placebo (P = 0.05). For the group treated with vitamin A, the risk
of death or a major complication during the hospital stay was half that
of the control group (relative risk, 0.51; 95 percent confidence interval,
0.35 to 0.74). CONCLUSIONS. Treatment with vitamin A
reduces morbidity and mortality in measles, and all children with severe
measles should be given vitamin A supplements, whether or not they are
thought to have a nutritional deficiency.

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